Bleeding from Varices: Still a Heavy Burden in Patients with Cirrhosis
Published on: 27th December, 2023
Introduction: Bleeding from varices is a severe complication in patients with cirrhosis. Despite its treatment has been well established in the last three decades the mortality can be still high. This study compares the epidemiological features and the bleeding-related outcomes of a group of patients published about ten years ago with a more recent group of 168 consecutive patients. Methods: The diagnosis, the treatment, and the main outcomes (5-day failure, 5-day and 6-week rebleeding, 5-day and 6-week mortality) of variceal bleeding were evaluated according to the current guidelines.Results: The number of patients with cirrhosis admitted for variceal bleeding every year has progressively decreased in the last ten years. The age sex and severity of liver disease, evaluated with Child Pugh and MELD scores, were comparable in the two series. In the more recent series, there were significantly fewer patients with HCV infection and more patients with alcohol-related cirrhosis. The main outcomes of bleeding were comparable too. Overall, at 6 weeks 36.4% of patients did not overcome the bleeding episode. Conclusion: The decreasing incidence of bleeding from varices is likely attributable to antiviral treatment of HCV and HBV and the larger diffusion of beta-blockers in primary prophylaxis. Despite the larger application of the gold standard therapy, the mortality of variceal bleeding remains high in patients with cirrhosis.
Individual Treatment Trial of PIGV-Associated Mabry Syndrome with D-Mannose in a Young Child
Published on: 27th December, 2023
We describe the first individual treatment trial with D-mannose in a young girl with PIGV-CDG. PIGV-CDG belongs to the GPI anchor deficiencies leading to intellectual disability, dysmorphic features, epilepsy, and, less frequently, organ malformations. A hallmark of the GPI anchor deficiencies is the elevated serum alkaline phosphatase (AP). Our patient carried the germline homozygous PIGV variant c.1022C>A, p. (Ala341Glu), the most commonly reported pathogenic variant leading to PIGV-CDG so far. We aimed to improve the impaired enzymatic function of PIGV through elevated substrate levels by giving D-mannose orally. We monitored the clinical status, developmental progress as well as serum AP levels. Our patient experienced no side effects. Standardized developmental testing showed better developmental progress during the 21-month treatment period with D-mannose than in the 12 months following the discontinuation of treatment. The D-Mannose treatment might have had a positive effect on the development of our patient with PIGV-CDG.
Generation of Curved Spacetime in Quantum Field
Published on: 19th January, 2024
To reach such a consistent theory which contains the quantum field theory of particle physics and Einstein’s theory of gravitation as limiting cases, one may proceed in the following way: Standard quantum field theory just ignores the effects of gravity. This is justified in many cases due to the weakness of gravitational interactions at the presently accessible scales. In a first step beyond this approximation, one may consider an external gravitational field that is not influenced by the quantum fields. Here one may think of sources of gravitational fields that are not influenced by the quantum fields under consideration, as high-energy experiments in the gravitational field of the earth or quantum fields in the gravitational field of dark matter and dark energy. This approach amounts to the treatment of quantum field theory on curved spacetimes. The problem of quantization in curved spacetimes is now clearly visible. In Minkowski spacetime, there is a large group of symmetries that enforces a particular choice of vacuum by demanding the vacuum to be invariant. Such a criterion is absent for a general spacetime (M,g). We therefore do not know which state to choose as the vacuum. One might hope that the different prescriptions might be unitarily equivalent such that it doesn’t matter which state one takes to define the theory. Sadly this is not the case: The Stone-Von Neumann theorem is no longer valid for systems with an infinite amount of degrees of freedom. This means that unitarily inequivalent representations of the canonical commutation relations will arise, and it is not clear which equivalence concept representation is the physical one. In the second section of this chapter, we review the notions of Cauchy surfaces and global hyperbolicity.
Superior Gluteal Artery Pseudoaneurysm following a Periacetabular Osteotomy
Published on: 1st March, 2024
Periacetabular Osteotomy (PAO) is the gold standard for the treatment of hip dysplasia or acetabular retroversion. Due to the proximity of intra-pelvic arteries, there is a risk of iatrogenic vascular injuries, which can present with a delay and should be part of the differential diagnosis of significant pain following a PAO. We present the case of a never-described vascular injury following a periacetabular osteotomy in a 25-year-old woman who presented with gluteal pain 3 weeks after surgery. A delayed diagnosis of a pseudoaneurysm of the superior gluteal artery was made and successfully treated by embolization. The lesion is most probably related to the tip of a screw or to the drilling process.
Effect of Lower Extremity Training in Diabetic Peripheral Neuropathy
Published on: 12th February, 2024
Background: Diabetic peripheral neuropathy is a symmetrical length-dependent sensorimotor polyneuropathy due to chronic hyperglycemia. The World Health Organization (WHO) identified diabetes as a major global health concern. Diabetic neuropathy is characterized by motor dysfunctions (weakness and atrophy) especially at the distal muscles of lower limbs, and impaired dynamic muscular control in type 2 diabetes patients. Symptoms start in a distal-to proximal pattern in the feet, and ankle and proximally in the hip and knee for both flexors and extensors. Proximal muscle weakness affects postural stability. Dorsiflexor weakness causes increased hip, knee flexion and metatarsophalangeal extension in the initial swing whereas weakness in plantar flexors causes a greater amount of hip and knee flexion during the stance phase.Methodology: 34 subjects with Diabetic Peripheral Neuropathy who fulfilled all the inclusion criteria were recruited for the study. Ethical standards have been maintained and informed consent was taken. Subjects were randomly assigned by lottery method into two groups, intervention, and control with 17 in each. Since it is a single blinded study subjects were blinded about the interventions provided. Pre and post-test scores were taken before and after 4 weeks using Surface Electromyography (sEMG), Kinovea Software, Functional Gait Assessment (FGA) and Short Form -36 (SF-36).Results: The pre and post-score values of the kinematics of gait, Functional Gait Assessment, and Short Form - 36 were analyzed using a Paired t-test and Wilcoxon Signed Rank test within the group analysis, Mann- Whitney U test and Independent t-test for between the group analysis. Both groups displayed notable variations, whereas the intervention group exhibited more significant differences (p < 0.05). Thus, it can be inferred that lower extremity training significantly improves gait kinematics and quality of life in diabetic neuropathy.Conclusion: Lower extremity training is effective in improving the kinematics of gait and quality of life in diabetic neuropathy.
Mapping the Psychosocial: Introducing a Standardised System to Improve Psychosocial Understanding within Mental Health
Published on: 9th February, 2024
Objective: Psychosocial approaches are increasingly being advocated as an efficacious means of addressing mental health problems. However, with a multitude of complex and varying interpretations present with the use of the term ‘psychosocial’ / ‘psycho-social’ in contemporary discussions of mental health, its application can be vague and even contradictory. This presents problems for research to inform practice and practice to inform research, ultimately inhibiting the help given to those suffering. Method: Literary review, reflecting an extended period of 10 years, explores and analyses the use of the terms ‘psychosocial’ and ‘psycho-social’ within a mental health context. Results: This article identifies that applications and use of the term psychosocial vary significantly, with two models being primarily evident in mental health applications: a multidisciplinary and interdisciplinary model. Conclusion: A standardised system is established for mental health theorists and practitioners to identify and categorise these different applications. This outcome is intended to lead to a better understanding of different psychosocial applications, provide better communication between existing psychosocial applications, and improve clarity for future instruction.
Assessment of the Quality of Life of the Caregiver of Pediatric Patients with Chronic Kidney Disease in a Tertiary Health Care Facility
Published on: 6th March, 2024
Background: Long-term care for patients with chronic kidney disease, whether in the pre or post-dialysis period, has a destructive impact on patients and their caregivers that can significantly worsen their quality of life. Objectives: To assess the quality of life (QOL) among caregivers of children suffering from chronic kidney disease and to identify the possible factors affecting their quality of life. Subjects and methods: Between March 2023 and May 2023, a cross-sectional questionnaire-based study was conducted at King Saud Medical City for caregivers of all pediatric patients aged from 6 months to 14 years with CKD stage-3B and beyond who have been followed up for at least three months in the pre or post-dialysis period since 2015. The study applied the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate the caregivers’ quality of life. Result: A total of 95 caregivers were involved in the study. The age ranged between 24 and 53 years, with an arithmetic mean of 39.3 and a standard deviation of (± 6.6) years, and almost two-thirds (65.3%) were Saudi nationals. Most pediatric patients were on peritoneal renal dialysis (41%), whereas 29.5% were on hemodialysis. The mean and SD of the overall score was 56.10 ± 17.40 out of a possible range of 0-100. Regarding its domains, the highest score was observed regarding the social domain (62.11 ± 21.12), whereas the lowest was the physical domain (49.55 ± 18.42). After controlling for confounding, married, high socio-economic, and more educated caregivers have higher QOL scores than singles, low socio-economic, and lower knowledgeable caregivers, and the three factors together were responsible for approximately 41% variability of the QOL score (r – square = 0.406). Bivariate Pearson correlation showed significant correlations among different quality-of-life domains (p < 0.001). Conclusion: There was a significant association between quality-of-life scores and demographic characteristics of chronic kidney disease caregivers; they need the highest support to cope with their delicate patients.
A Low-cost High-throughput Targeted Sequencing for the Accurate Detection of Respiratory Tract Pathogen
Published on: 12th March, 2024
Introduction: The current gold standard for SARS-CoV-2 diagnosis by real-time RT-PCR has limitations of gene numbers that can be detected. In this study, we developed a low-cost and high-throughput next-generation sequencing technology that can overcome the limitations of RT-PCR. Methodology: A targeted sequencing panel (TSP) consisting of approximately 500 amplicons was designed that can simultaneously detect a broad range of gene loci of SARS-CoV-2 and genes for the most common viruses of respiratory infectious viruses in a single run of up to 96 samples. 448 samples and 31 control samples were examined independently with both TSP and RT-PCR, results were compared for accuracy and other indicators. Results: TSP identified 50 SARS-CoV-2 positive samples with a 99.33% match to RT-PCR results. It is not surprising that TSP also identified multiple viral infections from 96 samples, whereas RT-PCR could not. TSP demonstrated its ability to conclude diagnosis for those undecided from RT-PCR tests. Conclusion: Our data demonstrated that TSP is a fast and accurate test for detecting multiple pathogen infections of the respiratory tract.
Large Cystic Dilatation of the Common Bile Duct
Published on: 19th March, 2024
Li B, Chen BW, Xia LS. The Initial Experience of Laparoscopic Management for Type VI Choledochal Cyst in Children. J Laparoendosc Adv Surg Tech A. 2024 Mar;34(3):280-283. doi: 10.1089/lap.2023.0229. Epub 2023 Oct 16. PMID: 37844069.
Dumitrascu T, Lupescu I, Ionescu M. The Todani classification for bile duct cysts: an overview. Acta Chir Belg. 2012 Sep-Oct;112(5):340-5. doi: 10.1080/00015458.2012.11680849. PMID: 23175921.
Dutta S, Jain A, Reddy A, Nelamangala Ramakrishnaiah VP. Anomalous Pancreaticobiliary Duct Junction in an Unusual Case of Synchronous Gallbladder and Bile Duct Malignancy. Cureus. 2021 Feb 13;13(2):e13331. doi: 10.7759/cureus.13331. PMID: 33738174; PMCID: PMC7959653.
Xia HT. Standardized Surgical Management for Cystic Dilation of the Bile Ducts Based on Clinical and Pathological Studies: A Narrative Review. Gastroenterol Res Pract. 2020 Sep 15;2020:3432786. doi: 10.1155/2020/3432786. PMID: 33014038; PMCID: PMC7512076.
Factors Influencing Knowledge on the Completion of Treatment among Tuberculosis Patients under Directly Observed Treatment Strategy (DOTS) in a Selected Health Facility, the Bahamas
Published on: 25th March, 2024
Objective: To determine the factors influencing completion of DOTS in Tuberculosis treatment in the Bahamas.Methods: A quantitative, descriptive cross-sectional survey. Tuberculosis patients aged 18 years and above were considered regardless of the site or the smear status of their TB. The sample size was 40. Data analysis and interpretation were done using the statistical package for the social sciences software (SPSS version 24), through the exploration and calculation of descriptive (frequencies, percentages, means, standard deviations, and inferential (Anova) statistical methods. Statistical significance was determined to be a p < 0.05. Results: The mean age of the respondents, was 39.9 years, SD 11.65, and 73% of them were men. 63% of participants, 78% of whom were citizens of the Bahamas, reported having no annual income. Seventy-eight percent (31) of the participants said they had insufficient food and drink while they were unwell. More than half of the participants in the survey reported being on at least one pharmaceutical regimen, although 36% said they were not actively taking any of the prescription medications.Conclusion: Less than a third were noncompliant with DOTS, this was influenced by factors such as annual income, no family support, marital status, employment status, and educational level.
Endoscopic Endonasal total Removal of a Suprasellar, Preinfundibular Retro Chiasmatic Craniopharyngioma: A Surgical Case Report
Published on: 26th March, 2024
Craniopharyngiomas are benign tumors (WHO Grade I), seen in children and adults. Because of their location, they can require challenging clinical and surgical management. In fact, often, because of the presence of calcifications, of a capsule very strongly adherent to neurovascular structures, of the relationship with hypophysis, pituitary stalk, chiasm, carotids, the circle of Willis, basilar artery, and third ventricle, risk of mortality and morbidity is still mandatory. Various surgical techniques have been proposed: transcranial, transsphenoidal, and supraorbital approaches for surgical resection and treatment of craniopharyngiomas. Still, there is no common consent, but often the endonasal transsphenoidal extended procedures are considered the gold standard in many cases. We present a surgical technique of a case of complete surgical removal of an infundibular and retro chiasmatic craniopharyngioma, via an endoscopic endonasal transphenoidal transplanum approach.
CVS: An Effective Strategy to Prevent Bile Duct Injury
Published on: 2nd April, 2024
Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting.Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.
Drinking-water Quality Assessment in Selective Schools from the Mount Lebanon
Published on: 2nd April, 2024
The present study aims to assess and compare the quality of drinking water according to WHO Standards and then illustrate the resulting diseases. Eight samples have been taken from selective different schools in the Mount Lebanon Region. The laboratory tests of the collected samples were performed to determine various physical (e.g., temperature, pH, electrical conductivity, etc.), chemical (Ca+2, Cl-, Fe, Mg2+, NO3, Na+, SO2-4), and microbial such as E. coli, coliform, and non-coliform. Several techniques were used for the analysis including Atomic Absorption Spectrometry, Flame Photometer, and Total Organic Carbon (TOC). The resulting water quality was compared with the standard limits. Each school has different defects according to specific contamination that existed. To save local residents and according to the results of this study, regular monitoring for water quality was proposed; besides more water filtration plants should be installed to provide safe drinking for children’s health.
Approaching Mental Health Through a Preventive Data Analysis Platform
Published on: 3rd April, 2024
The rising prevalence of chronic diseases and the aging population globally are diminishing the overall quality of life, especially for those with demanding daily routines. As medical advancements extend lifespans, the proportion of individuals over 60 is set to double by 2050, necessitating societal shifts toward health-responsible citizenship. Despite longer lifespans, evidence suggests that older age often accompanies mental health challenges such as anxiety, depression, and substance misuse. Social isolation and loneliness further compound these issues, affecting both physical and mental well-being. Digital wellness empowers individuals to take charge of their health, promoting proactive care and literacy to foster health-conscious citizenship. This paper explores the intersection of mental health, aging populations, preventive wellness initiatives, and health literacy, emphasizing their significance within the Health 5.0 framework, especially for older adults. Traditionally, health regulators offer static workflows for adopting standard procedures in health and well-being, reflecting a reactive approach. However, the evolving landscape of wearable and mobile devices connecting to healthcare IT systems through secure online networks necessitates a shift. Technology now facilitates remote patient monitoring and telemedicine service subscriptions and empowers individuals to manage their health proactively.The BE4YOU project, conducted in Portugal, serves as a case study, facilitating individual maintenance of health and well-being through intelligent and dynamic workflows, which are defined based on analytical models considering each person’s risk profile. By facilitating data sharing, promoting healthy lifestyles, and enabling early detection of mental health issues, the project leverages technology to support personalized monitoring and enhance overall health outcomes. Through technology-driven empowerment, individuals and healthcare professionals are better equipped to assess risks and ensure ongoing wellness monitoring, underscoring the role of technology in fostering personal health and supporting healthcare effectiveness.
Reducing CO2 in Passive House Adapted Low-cost Tropical Homes?
Published on: 26th April, 2024
The background of this novel study is how to apply an empirically adjusted Passive House concept in the tropics - beyond its otherwise prevailing global standards. Even though well-insulated houses have been on the planet since people settled down in some of their first dwellings, passive in the 21st century is different. It includes strict rules for airtightness and fitting of windows along with a sophisticated concept for artificial ventilation. Fresh air reachable from outside by filtered ventilation with heat recovery describes the heart of the system - if natural outside air is not preferable, it is convenient just in seasons with thermal comfort.Hence, the purpose and aim of the study presented here is to use a less common and at the same time more cost-saving approach: It might seem that the modern type of passive house entails the same standards that have been developed firmly on its own global market niche. However, this article tries to contribute toward a new development of modern passive homes for low-cost affordable tropical and subtropical houses in their entirety.As a concluding note, the author states that nobody has ever disproven this evolving concept as a combination of airtightness and a new way of forced ventilation without heat- or coolness recovery which is highly applicable for low-cost residential areas in tropical countries. By generating lower temperatures, it can help to surpass the overheating caused by climate change in certain tropical climate zones in higher altitudes and during cooler seasons. The condition is that the occupants are willing to accept a thermal comfort of up to 28 °C and humidity in its 70s and 80s.
A Critical Review on Some Recent Developments in Comparison of Biological Sequences
Published on: 25th April, 2024
The present review highlights some of the very important contributions to non-alignment ways of comparing biological sequences, which may be genome sequences of nucleotides, protein sequences of amino acids, or sequences of protein secondary structures. The discussion centers around specific methods applicable to the comparison of three types of sequences. The methods of comparison of genome sequences are based on three pairs of biological groups of nucleotides; the same for protein sequences are based on either physio-chemical property values of amino acids or on classified groups of amino acids of different cardinalities obtained from the physio-chemical properties; the same for sequences of secondary structures of proteins are based on their sequential expressions of structure elements of cardinality three and four. Comparison is made in the time domain and also in the frequency domain. Different taxa of known phylogeny are considered for comparison. It tries to find out the specific method of comparison, which can show the exact phylogeny of the taxa. If a new sequence appears in the database, it becomes essential to know its phylogeny. For this purpose, a phylogenetic tree is drawn on the sequences of the known taxa together with this new sequence using the best possible method. If the species having this new sequence belongs to the old taxa, there is nothing to worry about. Otherwise, the species with the new sequence has to be studied separately. This is the general reason for the construction of a phylogenetic tree in any form of biological sequence comparison.
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